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The History of Anesthesiology Reprint Series: Volume 23

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The History of Anesthesiology Reprint Series: Volume 23 The History of Anesthesiology Reprint Series: Volume 23 THE ROVENSTINE LECTURES Part One PHOTOGRAPHS FOUR STAGES IN THE LIFE OF E. A. ROVENSTINE, M.D., 1895-1960 History of Anesthesiology Reprint Series Volume 23, 1993 The Rovenstine Lectures The Rovenstine Lectureship was endowed in 1962 by the E. R. Squibb Pharmaceutical Company soon after his untimely death to commemorate the life and lasting contributions to anesthesiology of Emery Andrew Rovenstine. Although a true pioneer, he is more accurately depicted as a second generation anesthesiologist who established the department at New York University - Bellevue Hospital Medical School in 1935. Having come from Indiana, Middle West, as did the other pioneers, he was one of those early trainees in Ralph M. Waters' newly established residency training program at Wisconsin, then to come east. Everyone will agree that in the long run an exemplar and teacher is best remembered in the personas of his disciples. This dictum is amply substantiated by way of the Wisconsin Aqua Alumni Tree, a figurative representation of those who have become chairpersons of academic departments throughout the world. Rovie's branch, a stout outgrowth at the base of the trunk, is a fertile one with ever so many bifurcations. Over the years there have been some 31 Rovenstine lectures which subtly reveal the burgeoning and ramifications of our specialty, perhaps as a pentimen- to of Rovie's aspirations. Originally the lecturers were chosen by the Chairman of the Section on the Annual Meeting, latterly by the President of the ASA. We present here a sampling of those orations which subsequently appeared in the journal, Anesthesiology. More than a few Rovenstine descendants are thus rep­ resented along with an illustrious cohort of other leaders in Anesthesiology. With the enthusiastic approval of B. Raymond Fink, Chairman, and the Com­ mittee on Publications of the Wood Library-Museum, Leroy D. Vandam, M.D. History of Anesthesiology Reprint Series Volume 23 The Rovenstine Lectures Selected Papers Parti 1. Papper, E.M. Regional Anesthesia: A Critical Assessment of Its Place in Therapeutics (1966) 2. Dripps, Robert D. The Physician and Society. (1970) 3. Eckenhoff, James E. A Wide-angle View of Anesthesiology. (1977) 4. Vandam, Leroy D. Anesthesiologists as Clinicians. (1979) 5. Hershey, S.G. The Rovenstine Inheritance -A Chain of Leadership. (1982) 6. Keats, Arthur S. Cardiovascular Anesthesia: Perceptions and Perspectives. (1983) 7. Michenfelder, John D. Neuroanesthesia and the Achievement of Profession­ al Respect (1988) 8. Hornbein, Thomas F. Lessons from on High. (1989) 9. Stoelting, Robert K. Clinical Challenges for the Anesthesiologist. (1990) -1- REGIONAL ANESTHESIA A Critical Assessment of Its Place in Therapeutics by E. M. Papper, M.D. E. A. Rovenstine Memorial Lecture Introduction THE subject for the Fifth Annual Rovenstine ogy and to our society. However, it is safe to Memorial Lecture is "Regional Anesthesia—A say that during the last 25 years, he has served Critical Assessment of its Place in Therapeu­ us well on virtually every scientific and edu­ tics." The theme is altogether fitting for the cational committee and board in anesthesiol­ occasion since this problem was of particular ogy, both nationally and internationally. He is interest to Dr. Rovenstine for many years. In Professor and Chairman of the Department of thinking about one who should give this ad­ Anesthesiology at Columbia University and dress, it quickly became apparent that it most recently he has served us as the first Vice would be eminently appropriate to invite one President of our Society and as Principal Con­ of Dr. Rovenstine's most illustrious students; sultant to the National Institute of General our speaker is just such a person. He is also Medical Sciences of the National Institutes of the first anesthesiologist to serve as the Roven­ Health in Washington. It gives me great per­ stine Lecturer. I will not attempt to enu­ sonal pleasure to present the Rovenstine Lec­ merate his many contributions to anesthesiol­ turer for 1966, Dr. Emanuel M. Papper. Regional Anesthesia A Critical Assessment of Its Place in Therapeutics E. A. Rovenstine Memorial Lecture E. M. Papper, M.D* I FEEL signally honored to have the privilege recent developments in this field. Before of giving the annual Rovenstine Lecture. The doing so, I wish to pay a short tribute to a honor is heightened by both pleasure and hu­ great man, in words which, I hope, will also mility. My years with him were cherished. set the background for the remainder of this The opportunities which he provided for me lecture in his honor and in his memory. are impossible to describe fully and I cannot E. A. Rovenstine was one of the most dis­ express sufficiently my gratitude to him. I tinguished of anesthesiologists of his time. He have undertaken a critical discussion of a sub­ may very well have had a greater influence on ject that was dear to his heart—a field that the development of this specialty than any has always fascinated me as it did him—the other physician because of his versatility as a field of therapeutic and diagnostic nerve blocks. teacher, clinician, and clinical investigator. It is one that I find perplexing now. I wish Born in Atwood, Indiana, in 1895, and edu­ to share these controversial and puzzled views cated at Wabash College and Indiana Uni­ with you, from the perspective of old and versity, Rovenstine came to New York from Wisconsin in 1935 to start the first academic * Professor and Chairman, Department of Anes­ department of anesthesiology in that city. His thesiology, Columbia University College of Physi­ cians and Surgeons, New York City. medical interests were incredibly wide and his Presented at the Annual Meeting of the Ameri­ skills magnificent. He was far ahead of his can Society of Anesthesiologists, Philadelphia, Oc­ tober 5, 1966. time in recognizing the future importance of 1074 Volume 28 E. A. ROVENSTINE MEMORIAL LECTURE Number 6 1075 the physical as well as the biological sciences to anesthesiology. He predicted as early as 1947 that physics, electronics, and even auto­ matic devices would one day have a great impact on clinical anesthetic practice. He had a remarkable interest in the appli­ cation of regional anesthetic procedures to surgical operations. He extended this interest thereafter to the study and therapy of other diseases, many of them painful: hence our dis­ course today. He brought the knowledge of the anesthesiologist in the control of pain to aid in the diagnosis and therapy of many dif­ ferent diseases. His favorite clinical problems for regional block were patients with trigemi­ nal neuralgia, the painful shoulder, and the causalgic states. The pain of cancer interested him to a lesser degree, an irony of sorts in view of his eventual tragic battle with a pros­ tatic cancer which finally took him from us in 1960. His marked curiosity and interest in painful states was a logical development in view of the opportunities that Rovenstine had and uti­ lized to further this particular skill. He was, in fact, almost preoccupied with this aspect of E. A. Rovenstine, M.D. anesthetic care. His interest in this field be­ gan when he met Gaston Labat, the distin­ tedious application necessary in the compila­ guished French surgeon who had turned re­ tion, digestion, and production of material for gional anesthetist. Labat at that time was per­ bookwriting. He preferred to look forward to forming much of the regional anesthesia in new things rather than write about the old— Bellevue Hospital and also consulted at The even though he wrote easily and with a grace Presbyterian Hospital in New York. Roven­ that had ever so small a touch of the flowery. stine also became a close friend of another However, he did secure from Madame Labat surgeon interested in regional anesthesia who a large collection of drawings and plates which remained a practicing surgeon, Dr. Hippolyte were to be used for a subsequent edition of Wertheim. The welding of the superb ana­ the book. Some of these magnificent drawings tomical knowledge of Wertheim and the amaz­ have, fortunately, not been lost, and were uti­ ing technical skill of Labat with the inquisi­ lized by Vincent J. Collins in his textbooks tive scholarly and clinical knowledge of Rov­ on anesthesiology. Many drawings and plates enstine, resulted in a cohesive direct attack were also commissioned and drawn by a now upon the problems of diagnosis, prognosis and well-known artist, a friend of mine from World therapy of diverse abnormalities which had in War II days, Carroll N. Jones, Jr.; some of common only the transmission of impulses, these have also appeared in Collins' works. painful or otherwise, over nerve pathways. Rovenstine's interest in this subject carried Rovenstine's interest in therapeutic nerve him even further. He instituted courses in block carried him to the point where he in­ cadaver dissection in regional anesthesia which tended to write, with Madame Labat's ap­ were available to the residents of the Bellevue proval, a second edition of Labat's classic book Hospital Department and were also highly on Regional Anesthesia. He never produced popular with anesthesiologists from other parts this work because he disliked the discipline of of the country. Among the students in these EMANUEL M. PAPPER Anesthesiology 1076 Nov.-Dec. 1967 TABLE 1. Summary of Recent Experience at The some of the questions that need to be asked. Presbyterian Hospital with Nerve Blocks It is important to state at this point that one of the tacit assumptions always made by the Diagnostic and Therapeutic Nerve Blocks writers in the field is that the simple interrup­ Period 4.5 years tion of a conducting pathway is destined by (1962-1966) that very act to prevent noxious, harmful or painful impulses from reaching the central Total 1336 nervous system, and therefore to alleviate dis­ Diagnostic & comfort.
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